Abstract
Hand Trauma Aetiology and Anaesthesia during the first UK lockdown: “Lessons for Future Lockdowns”.


Aims

The hand unit at the Queen Victoria Hospital, East Grinstead, UK is a tertiary referral centre serving a population of 4.6 million across the South East of England. On 26th March 2020 until 10th May 2020 the UK was placed in an unprecedented national lockdown in response to the COVID-19 pandemic, with advice to all citizens to avoid non-essential travel and work from home wherever possible. This study aims to understand the effects of lockdown on hand trauma aetiology and anaesthetic choices for emergency hand surgery.

Methods

Retrospective data collection using review of clinical notes for all patients who underwent surgery of any kind for hand trauma in April 2020, matched with the same period in April 2019. Fisher’s Exact Test was applied to assess for difference in method of anaesthesia, injury location (workplace vs home) and DIY versus non-DIY aetiology.

Results

165 patients had surgery in the 2020 cohort versus 239 in 2019 (31% decrease). The mean age was 45 during lockdown vs. 49 in 2019. There was significant reduction in the proportion of workplace injuries in 2020 (22.3% vs 44.1%, p<0.0001), however, the proportion of power tool injuries was similar (31.6% 2020 vs 26.6%, NS). DIY injuries increased significantly (33.5% vs.9.2%, p<0.0001). Use of local anaesthesia including WALANT increased significantly in our unit (84.2% in 2020 vs. 66.1% 2019) with a major reduction in use of general anaesthesia (0.6% vs. 9.2%, p<0.0001)

Conclusions

Caseload somewhat reduced during lockdown. Fewer injuries occurred in the workplace. Our unit substantially increased usage of local anaesthetic techniques to avoid regional anaesthesia (and risk of requiring conversion to GA). Power tools and DIY accounted for a large proportion of injuries and we encourage widespread dissemination of the BSSH (Britsh Society for Surgery of the Hand) #StayHomeStaySafe campaign.

Key words: Hand Trauma, Aetiology, Lockdown, WALANT